Transgender Children and Youth

I BEGAN SEEING MARCO (NATAL FEMALE) WHEN HE WAS IN fifth grade. His mother brought him to see me because a few months earlier he had told a school guidance counselor he was transgender and wanted to attend school as a boy. The guidance counselor then called his mother. While surprised by this news, Marco’s mother indicated that she was supportive whatever his gender identity or expression.

We met from November through the following June. Over the course of my exploring Marco’s sense of himself, meeting with his mother, and the two of them together, Marco remained clear about being a boy. At the end of fifth grade, Marco was emphatic about beginning middle school (sixth grade) as a boy. His mother and I agreed this was the right step. She met with his new school in August, and in September her son started middle school as Marco.

As he and I met each week, I checked in about how it was going at school. Were his teachers using “Marco” and male pronouns? How were his peers responding (some of whom had known him in elementary school)? Was he encountering any difficulties? Was anyone teasing him or asking personal questions? About two months into the school year, I asked these questions again. “How’s it going being in sixth grade as Marco?” Marco’s response was, “Well you know, now I can just do my work.”

This opened up a conversation about how hard it had felt the year before, how distracted he had felt when his teacher and classmates saw him as a girl, how much he had hated going to school and hated hearing the girl’s name everyone used for him. Socially transitioning and attending school as Marco removed these distractions and distress. Consequently, he was able to simply focus on what he was learning in classes. As the year went on, Marco’s peer interactions and grades improved significantly compared to the previous year.

Marco was one of my first adolescent transgender clients. His response about simply being able to focus on his work caught my attention. It highlighted how much mental and emotional energy trans and gender-diverse youth expend not being seen in their affirmed gender—how distracting this can be, how much it keeps them from being present, and the extent to which this can interfere with academic enjoyment, performance, and success. Marco’s growth and progress that next year illuminated the wide-ranging positive impact for a transgender young person allowed to fully be who they are in the world.

This chapter addresses transgender children and adolescents within educational settings. It begins by exploring ways to inform schools about a young person’s social transition, including key issues, possible requests, and necessary decisions when meeting with school personnel. It outlines strategies to ensure that the school maintains a safe and positive learning environment as the young person attends school in their affirmed gender. This is followed by current research about harassment and bullying within schools and its impact on transgender and gender-diverse youth.

The second half of this chapter describes best practices to create and maintain supportive, inclusive environments for transgender and gender-diverse youth (and consequently for all students) within school settings. It reviews the May 2016 U.S. Education Department’s Office for Civil Rights and U.S. Department of Justice’s Civil Rights Division’s Dear Colleague Letter (“DCL”) affirming that all U.S. schools are prohibited from discrimination on the basis of gender identity or expression under Title IX of the Education Amendments of 1972 (20 U.S.C. §§ 1681–1688) and explicitly charged with protecting transgender students.

While many of these policies and practices are relevant to other youth organizations, the final section addresses additional considerations that may emerge in settings such as day and/or overnight camps and community youth programs (scout groups, sports teams, and arts, music, and performance activities). In addition to providing support for transgender and gender-diverse youth and their families, the chapter emphasizes the important role mental health providers can play in educating schools and advocating the full inclusion of trans and gender-diverse young people. The chapter ends with a series of best practice guidelines for schools, agencies, and other organizations.

It can be helpful to begin a child’s social transition at school on the first day back from a break in classes. When possible, many families choose to have their child or adolescent socially transition with the start of the school year in September. This creates a fresh start with new teachers, who meet the young person in their affirmed gender and begin using their affirmed name and pronouns at the onset of the academic year. This can facilitate the consistent use of the youth’s affirmed name and pronouns more smoothly as opposed to the teacher needing to shift to a new name midway through the year.

However, decisions about when a young person or family is ready to transition at school do not always fit this timetable. Some families begin social transition after the December/January break or upon returning from spring break. While teachers and classmates knew the young person in their birth-assigned gender and name for part of the school year, beginning after a break in classes creates a clear first day when the new affirmed gender is announced and recognized.

Other families simply agree on a start date with the school without connecting it to a school break (typically on Monday at the start of a new week). For preschool and elementary school youth, it may be less critical to begin a school transition in conjunction with the return from a break. Younger peers typically make the shift to a child’s new name and affirmed gender more easily, without extensive explanations or discussion.

There are situations when the young person can begin going by their affirmed gender when they start a new school. This might be at the beginning of middle or high school. Some families relocate or find other ways for their child to have a complete new beginning in their affirmed gender, with neither teachers nor classmates having known the child prior to their social transition. At times, this choice is made because the parents and young person do not perceive the current school environment as supportive of transgender youth. Other times, the young person does not want to navigate, or feel capable of navigating, the disclosure and adjustment period that occurs when trans youth socially transition in a school where they were previously known in their birth-assigned sex/gender.

Social transitions at school begin with a meeting between the parents and the school. If the young person is older, they may also participate in this meeting. In the lower grades, where the child has a single teacher and classroom, the conversation often begins with parents informing the teacher that the child will be socially transitioning. The conversation typically moves from there to a meeting with a school guidance counselor or principal.

With middle and high school youth, if the parents have an existing relationship with someone at the school, such as a guidance counselor or assistant principal, it can be helpful to begin the conversation with that staff member. They are often able to outline next steps in terms of other staff who need to be included in planning and decision-making.

The initial focus of these meetings is disclosure about the child’s gender identity and the intent to have the young person begin attending school in their affirmed gender using a new name and pronouns. During these meetings, the parents discuss how they would like their child’s transition to be announced at school and in classes and discuss what type of accommodations may be necessary.

When the school has previously worked with transgender or gender-fluid students, the staff generally have basic knowledge about gender identity and expression and may have already developed policies for navigating the transition. If this is the first time a school has had a transgender students, the parents will need to be prepared to educate the staff—or point them to existing resources. They should also be prepared to advocate specific policies or accommodations. In these situations, mental health providers can play a key role in advocating the needs and rights of the young person.

It can be helpful for the parents to take some basic literature to this meeting or make it available to school staff beforehand. Possible resources include:

ºLambda Legal (http://www.lambdalegal.org/know-your-rights/youth/tgnc-friendly-schools)

ºThe National Center for Transgender Equality (http://www.transequality.org/know-your-rights/schools)

ºOCR “Dear Colleague” Letter on Transgender Students (http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201605-title-ix-transgender.pdf)

ºOCR Examples of Policies and Emerging Practices for Supporting Transgender Students (http://www2.ed.gov/about/offices/list/oese/oshs/emergingpractices.pdf)

In the past, schools sometimes required a letter about the child’s transgender or gender-fluid identity from their medical doctor or mental health provider that indicated that the child was diagnosed with gender dysphoria. However, the May 2016 DOE/DOJ letter explicitly states that transgender students do not need to produce a medical diagnosis or birth certificate; instead, a parent’s or guardian’s assertion that a student’s gender identity differs from previous records or representations is sufficient for the school to be required to recognize that student’s affirmed gender.

The first request is typically for the school and all personnel to begin using the child’s affirmed name and pronouns, even if there has been no legal name change yet. The school will generally not change the official school records without documentation of a court-ordered name change. However, parents still have the right to insist that the school find a way to ensure all class rosters reflect the child’s affirmed name.

Families need to ensure that all teachers are informed about the child’s gender transition and affirmed name and pronouns. This may be something parents want to do directly prior to the first day of the transition. Other times, the school will inform the teachers. It is important to ensure that school administration expects teachers to use the affirmed name and pronouns and communicates that this is essential for the student’s well-being.

Some schools with dress codes have adopted gender-neutral uniforms. When this is not the case, parents need to be clear that their child will attend school in the uniform that matches their affirmed gender.

Two areas that have been contentious at times with schools have been the use of gendered bathrooms and locker rooms. Trans-affirmative school policies allow transgender and gender-diverse students to use the restroom and locker room that matches their gender presentation or affirmed gender. Some schools may still initially refuse to allow this or insist that the young person use a single-stall bathroom and a separate locker room space.

However, the May 2016 DOE/DOJ directive affirms that transgender students must be allowed to use the bathroom that corresponds with their gender identity—and that to do otherwise is discrimination against trans students. In addition to this directive, many recent court decisions have ruled that the federal Title IX law banning discrimination on the basis of sex also prohibits discrimination on the basis of gender identity and expression.

Many transgender children and teens will want to use the restroom that matches their affirmed gender. Mental health providers can work with parents to assess which decision is best in terms of their child’s well-being and safety. This might include thinking about the particular school context and examining how safe a transgender boy will be in the boys’ bathroom or locker room (or a trans girl in the girls’ facilities). Children and adolescents are typically alone in bathrooms and locker rooms without adult supervision. This can create a risk for transgender and gender-diverse youth of being harassed or bullied by peers when adults are not present to intervene.

It is also generally possible for trans and gender-diverse youth to use an alternate restroom, such as one in the school nurse’s office. This alternative space may be chosen because of safety concerns, as indicated above. Other times, trans youth choose this option because they do not feel ready to navigate gender-segregated settings with their cisgender peers. The decision to use gender-segregated facilities should always rest with the young person. They should never be “pressured” into using a gendered facility before they want to do so.

However, there may be situations where parents believe they need to overrule the child’s choice about using gender-segregated facilities based on the concerns just discussed. When this occurs, it is essential to thoroughly discuss the reasons behind the parents’ decision, make space for the young person’s feelings to be expressed and acknowledged, and ensure that the young person understands that this decision does not reflect a lack of support or a denial of their affirmed gender.

Decisions about using gender-segregated or alternate facilities may evolve over time. A 14-year-old transgender girl may not feel comfortable using the girls’ room at the onset of her social transition at school. But she may feel completely ready to do so six months later as she becomes more comfortable navigating school as a girl and peers more fully know and accept her in her affirmed gender. Regardless of the ultimate decision, these factors need to be considered prior to the child’s social transition at school.

Historically, many schools balked at allowing transgender youth to participate in musical groups and sports that were gender-specific. John was actively involved with several school choirs prior to transition. When he began ninth grade as a boy, John asked to join the male a cappella choir. The music director was initially reluctant. After several conversations with the parents, John was allowed to join. However, the director required John to audition even though the a cappella choir was not an auditioned choir and none of the other singers were asked to audition.

Similarly, athletic coaches have resisted allowing transgender girls to play on girls’ sports teams or transgender boys to play on boys’ teams. With the May 2016 DOJ/DOE directive prohibiting discrimination against trans students, all schools must now allow transgender students to join the teams that match their affirmed gender.

It is essential that families and mental health providers know what rights transgender students are legally entitled to receive. Some states have enacted laws that prohibit discrimination against transgender people within their jurisdiction. However, currently there still are no federal laws prohibiting this discrimination. While the May 2016 directive issued by the Departments of Justice and Education serves this function for transgender students, it is likely that students and families will encounter school districts refusing to enforce the directive. Within days of its issuance, several lawsuits were filed challenging its requirements. It is also likely that some families will not be aware of the recent directive and the protections it affords them.

This means that mental health practitioners need to educate both youth and their families about the rights they are entitled to within their schools, informing them that the Departments of Justice and Education now require schools to allow transgender students to use the restrooms and locker rooms that match their affirmed gender and to participate in school groups, sports, and other gendered activities that match their affirmed gender. If the school requires students to wear a uniform, transgender students are legally entitled to wear the uniform that matches their affirmed gender. All schools are also now mandated to support trans students by using their affirmed name and pronouns.

Given that the directive may be contested for some time yet and some school districts may refuse to enforce the directive, organizations such as Lambda Legal and the Transgender Law Center can be helpful. These agencies will be tracking school districts that refuse to comply.

If you or someone you work with has experienced gender-based bullying, harassment, or discrimination at school, you (or they) have the right to file a complaint with the U.S. Department of Education’s Office for Civil Rights (OCR). The National Center for Transgender Equality provides guidelines for filing a complaint at the following link on their website: http://www.transequality.org/know-your-rights/schools.

Transgender students of any age have the right to privacy about their transgender history and identity. When a child first transitions, almost everyone at the school will know they are transgender. However, as the young person moves into successive grades or changes schools, new teachers will not necessarily know the child’s history. Some transgender youth, especially middle or high school students, may want to “be stealth” at school (a term used within the trans community to indicate trans people who are not out or open about their trans identity or history).

Many trans adolescents simply want to attend school as a “regular” girl or guy. While they might choose to come out to certain individuals, they may not want all of their teachers or peers to know their transgender history. The young people fear—often rightfully so, unfortunately—that once others learn they are trans, it will change the way their peers or teachers see them.

Given this, it is important for parents and young people to talk about—possibly with a mental health professional—where, how, and to whom they want their trans history or identity disclosed. Parents have the right to ask the school which staff will be told their child is transgender. Transgender children and adolescents also have the right to know who has this information. Both youth and their parents have the right to have this information kept confidential and disclosed only to school personnel with a need to know (perhaps a school nurse who might be involved in the child’s needing emergency medical attention).

Reinforcing this right to privacy is the fact that the young person’s transgender identity requires a psychiatric diagnosis of gender dysphoria. Consequently, the information is protected medical information. It should not be disclosed without the family’s awareness and permission. The only exception is a medical emergency where the information is needed.

If certain school personnel need to be aware of the young person’s gender identity, this must be shared with their parents. Both young people and parents have the right to know who these individuals are, as well as when, where, and how the information will be disclosed. For adolescents in particular, it can be profoundly uncomfortable to unexpectedly learn that a teacher or school staff member knows about your transgender identity or, worse yet, to be publicly outed by one of these adults, even if unintentionally. In some contexts being outed like this may put them at risk of harassment or violence.

With younger children, families must think through how other parents in their child’s grade will be informed. Sharing this news can allow other parents to talk with their children about their classmate’s transition. Parents need to decide whether they want the school to disclose this information or whether they disclose the information themselves. I have worked with schools that wanted to share the information that a child was gender transitioning—typically because they believed this would help the process go more smoothly. I have also worked with schools that did not publicly disclose this information but instead addressed it on a case-by-case basis if other parents asked questions. When schools do disclose, this typically happens just prior to or on the first day the child attends school in their affirmed gender.

The Rights of Transgender Students (National Center for Transgender Equality

•You have the right not to be bullied or harassed because you are transgender or gender-nonconforming. If school administrators become aware of bullying or harassment, they must take action to end it.

•You have the right to equal educational opportunities regardless of your gender identity or expression or your race, nationality, or disability. This includes not being punished or excluded from school activities or events because you are transgender or gender-nonconforming.

•You have the right to present yourself in a way that is consistent with your gender identity, so long as you follow rules for how to dress that apply to all students.

•You have the right to use restrooms and other facilities that are consistent with your gender identity and can’t be forced to use separate restrooms.

•You have the right to privacy concerning your transgender status and gender transition. Any such information kept in school records must be kept private and not shared without your permission.

•You have the right to join or start a Gay–Straight Alliance or pride club and to have your group treated like other student groups.

GLSEN’s (the Gay, Lesbian and Straight Education Network’s) 2013 National School Climate Survey indicates that transgender, gender-queer, and other non-cisgender students faced the most hostile school environments. Additionally, gender-nonconforming cisgender students experienced more harassment at school than did gender-conforming cisgender students (Kosciw, Greytak, Palmer, & Boesen, 2014). Over half (56%) of the students reported that they often or frequently heard negative remarks about someone’s gender expression, such as about someone not acting “masculine” or “feminine” enough, with remarks about someone not acting “masculine enough” occurring more frequently. One third reported hearing derogatory comments about transgender people (such as “tranny” or “he/she”) often or frequently.

While these remarks were often made when teachers were not present, when school staff were present, only 10% of students indicated that they intervened most or all of the time. In addition, over half (55.5%) of the students had heard teachers or other school personnel also make negative remarks about a student’s gender expression (Kosciw et al., 2014). The pervasiveness of these remarks signals that transgender, gender-nonconforming, and gender-queer youth are viewed as “less than” and are not welcome in that school setting. This directly impacts a trans youth’s sense of self and safety. One young person said, “This past week has been nothing but ‘Is that a boy or a girl?’ said loudly behind me or people calling me ‘mangirl.’ It’s making school feel much more unsafe and I hate walking through the halls” (Kosciw et al., 2014, p. 22).

The frequency of these remarks by staff and students furthers a climate of hostility within the school. More than half of the students (55.2%) surveyed reported that they had been verbally harassed at school because of their gender expression, with one in five having been harassed often or frequently. Almost one quarter (22.7%) had been physically harassed (e.g., shoved or pushed) because of their gender expression (Kosciw et al., 2014).

Numerous studies have shown that transgender students experience increased marginalization and discrimination as well as higher rates of harassment and bullying than do their lesbian, gay, and bisexual classmates (Greytak et al., 2009; McGuire, Anderson, Toomey, & Russell, 2010; McGuire & Conover-Williams, 2010). Transgender students also reported the lowest feelings of safety at school (Greytak et al., 2009). This lack of perceived (and often real) safety contributes to increased absences and decreased academic performance among transgender students (Greytak et al, 2009). Transgender students also demonstrate fewer hopes and goals for their future than their cisgender peers.

These experiences of harassment and bullying can significantly impact the health and well-being of transgender, gender-nonconforming, and gender-queer children and adolescents. Studies have found that increased abuse is linked to poorer physical and mental health, is associated with greater risk of HIV and other sexually transmitted infections, and can lead to decreased psychosocial adjustment (Espelage & Swearer, 2008; Russell, Ryan, Toomey, Diaz, & Sanchez, 2011; Toomey, Ryan, Diaz, Card, & Russell, 2010). This overall marginalization, isolation, harassment, and bullying correlates with increased suicidal ideation and attempts, with 45% of trans youth in one study reporting thoughts about suicide and 26% having attempted suicide (Grossman & D’Augelli, 2007).

Given the increased risk of harassment and bullying, making a safety plan prior to the child’s attending school in their affirmed gender is essential. The plan needs to identify a safe adult at school to whom the young person can reach out at any time if they are ridiculed, harassed, or bullied by other students. This is often a guidance counselor or a school nurse that the youth can easily access.

In discussing a safety plan, it is important to “walk a line” between the need to establish the plan and creating fear or anxiety about the possibility of harassment. The majority of youth I have worked with have positive social transitions with their peers at school and do not experience harassment. At the same time, the young person needs to know whom to seek out if something does occur. Even if the transition at school goes well, it is important to periodically inquire whether the youth has experienced any harassment or bullying or an uncomfortable question or remark from a classmate or staff member.

Studies of youth overall (non-trans-specific) indicate that harassment and bullying occur most often in middle school, with sixth graders reporting the highest incidence (U.S. Department of Justice, 2014). This can include verbal harassment, such as being made fun of, called names, or insulted. It can be physical bullying, such as being pushed, shoved, tripped, or spit on. Sometimes the bullying involves students being forced to do things they don’t want to do. Being excluded or shut out of friendship circles is also a form of harassment and bullying that can create tremendous isolation for a trans youth. The incidence of bullying tends to decrease as young people move into Grades 10 through 12 (U.S. Department of Justice, 2014).

It is important to recognize that young people may be reluctant to speak out when they are being harassed or bullied. One study indicated that 17% of third- through fifth-graders had been bullied but did not report this to anyone. The number of young people not reporting they are being bullied increases steadily as grade level increases; 43% of 9th- through 12th-graders failed to tell anyone what was happening to them in school (Luxenberg, Limber, & Olweus, 2014).

Jimmy (natal female) began attending a private school as a boy as he started ninth grade. Things went smoothly that year. Jimmy did well academically, and his peers seemed very supportive. During the winter of 10th grade, Jimmy’s grades began to drop. There were several instances when he cut classes or left school early. His parents felt he was not taking school seriously, and we met for several family sessions to address what was happening. His next report card had several failing grades, and the school placed Jimmy on academic probation. A set of improvement goals were outlined, and when Jimmy failed to meet these goals, the school asked him to withdraw.

Throughout this time, Jimmy appeared fairly unconcerned about his grades, which of course further infuriated his parents. Though I asked several times whether something was happening at school that was bothering him and directly asked if anyone was making fun of him or bullying him, Jimmy said no. He completed 10th grade through an online program, and his parents placed him in a new school the following fall.

It was only after being at the new school for two months (and doing well) that Jimmy disclosed that several 12th-grade boys had been calling him names and pushing him around during the previous school year. Rather than telling anyone what was happening, Jimmy “set out” to get expelled. While this was clearly a “creative” and “successful” strategy, disclosing the bullying could have enabled Jimmy to process the abuse, prevented his expulsion from school, and decreased the conflict with his parents.

There are numerous reasons why a young person might not disclose harassment or bullying by classmates. There are negative messages about “tattling” or being a “snitch” among most youth. Many young people are also afraid that if they tell someone, the bullying will only get worse. For trans guys in particular (like cisgender boys), stereotypical expectations for men to be “tough” and not admit any vulnerability can often make it more difficult to acknowledge incidents of bullying.

Depending on the school response to incidents of harassment or bullying, youth may not trust that school personnel will intervene even if they do report what is happening to them. This may be especially true for transgender students. The GLSEN 2013 school climate report indicated that in addition to frequently hearing negative remarks about gender expression (not acting “masculine” or “feminine” enough) or negative remarks specifically about transgender people (e.g., “tranny” or “he/she”), 55.5% of LGBT students reported hearing negative remarks about gender expression from teachers or other school staff. Furthermore, 61.6% of the students who did report an incident said that school staff did nothing in response (Kosciw et al., 2014).

Given the reluctance many gender-diverse youth have about disclosing experiences of harassment and bullying, it is essential that parents, mental health providers, school counselors, and others recognize signs that may point to possible abuse. Signs that a student may be experiencing harassment or bullying include:

•Frequent headaches or stomach aches; feeling sick or faking illness to stay home from school

•Changes in eating habits (suddenly skipping meals, binge eating, coming home from school hungry because they did not eat lunch), difficulty sleeping, or frequent nightmares

•Declining grades, loss of interest in schoolwork, sudden loss of friends or avoidance of social situations

•Self-destructive behaviors, such as running away from home, harming themselves, talking about suicide, or suicide attempts (U.S. Department of Health and Human Services, 2016c)

Given the frequency of harassment as well as the reluctance many transgender and gender-diverse youth have about disclosing incidents of bullying, it is critical to develop a safety plan, proactively discuss reasons why young people might not report experiences of harassment or bullying, and work with the young person to identify a “safe” adult with whom they can disclose what is happening at school (or in other youth program/activity settings) should the need arise.

For teachers, school administrators, and parents the overarching aim must be to create, communicate, and maintain a safe, inclusive, and affirming learning environment for all students. To accomplish this, goals must be framed in terms of the school culture as a whole, and not simply focus on protecting transgender students alone. The best practices that follow do not simply make schools safe and affirming for trans and gender-diverse youth; these policies and practices make schools safe for all students—lesbian, gay, and bisexual youth; youth whose gender expression varies from what is considered normative for their birth-assigned sex; gender-expansive or gender-creative youth; youth whose gender identity and/or expression goes beyond the binary; and cisgender, gender-conforming, straight youth.

The policies and practices outlined here send a message that all students are safe and free to bring their “whole” selves to school, that every student can safely explore the many varied aspects of their identity, and that harassment and bullying are never acceptable by or toward any student. These policies and practices are essential regardless of whether the school is currently aware of transgender students in attendance.

The development of safe, inclusive educational settings is grounded in a fundamental belief in the inherent dignity of all human beings (including young people) and, concomitantly, that each person/student deserves to be treated with respect and kindness. This value stance guides the development of policies and practices that ensure that each individual in the school gives, and receives, respect and kindness. These policies must describe what respect and kindness look like in action—what behaviors or actions demonstrate these foundational values.

However, developing policies themselves is insufficient. To shape the academic environment, the school’s core values of respect and kindness, along with policies that ensure that these values are lived out in each arena of the school, must be communicated and continually reinforced by all school personnel.

The first step in creating a safe, affirming, and inclusive learning environment begins with adopting a policy that prohibits any kind of harassment or discrimination. This must be a written policy that is communicated to all school personnel, parents, and students. The underlying rationale for ensuring the absence of harassment or discrimination—that students cannot learn when they feel unsafe—must be clear. School personnel need to know that while they can hold any “personal” beliefs they choose, they cannot discriminate against, ridicule, or harass any student (or colleague, supervisor, or parent). Students as well need to understand that their personal beliefs or attitudes cannot be expressed in ways that harass or discriminate against their classmates.

These policies have sometimes been called “zero tolerance for discrimination” policies. However, there are many concerns about the language and effectiveness of zero-tolerance policies. In many settings, these policies serve as punitive approaches that administer consequences to students perceived to violate the guidelines. The consequences often include suspension or expulsion, which removes students from the school environment but does not necessarily contribute to changed behavior. Numerous studies indicate that zero-tolerance policies are largely ineffective and disproportionately applied to youth of color (American Psychological Association, 2008; National Association for the Advancement of Colored People, 2005; Wald & Losen, 2003; Witt, 2007).

While consequences can be appropriate in some situations, the first line of action in reducing instances of harassment, bullying, or discrimination needs to be an educational one that focuses on what we want students to do—practice kindness, respect, openness to diversity and difference, acceptance—rather than focusing on what we want them to stop doing. Schools need to educate students about the ways harassment, ridicule, and bullying harm others as well as the perpetrator themselves. This necessitates ongoing education and discussion about the school’s values and how they facilitate a positive environment for all students. When students’ actions do not demonstrate values of respect and kindness, simply punishing them does not typically effect change. Instead, school personnel must be willing to meet with these students and explore what might lie beneath this behavior as well as support them in building more positive social skills.

Creating a safe, inclusive environment must include educating students about the many ways human beings differ from one another. It must include discussion of our diversity as a strength, and thus something to be valued and celebrated. Students need to learn constructive ways to disagree with peers who hold divergent beliefs and opinions. They need to learn positive skills for resolving conflicts. Students need information and training on how to be an “ally” rather than a “bystander”—on how to speak up when someone is being teased or bullied. Overall, a proactive, preventive approach, marked by education, skills training, and positive reinforcement, is increasingly being recognized as more effective than punitive measures in creating safe, inclusive school environments (American Psychological Association, 2008; Boccanfuso & Kuhfeld, 2011; Smith, 2013). Advocates for Youth has an excellent curriculum titled Taking a Stand Against Bullying for teaching youth how to step forward when they see someone being bullied (http://advocatesforyouth.org/3rscurric/documents/4-Lesson-4-3Rs-TakingaStandAgainstBullying.pdf).

Given that many gender-diverse youth report hearing negative remarks about “non-normative” gender expression or about transgender people being harassed by peers in the presence of school personnel who fail to intervene, schools need clear policies that direct all personnel to address harassment and bullying when it occurs and then bring the incident to a supervisor’s attention. Some adults ignore instances of bullying because they perceive “teasing” to be “part of growing up” and fail to understand its negative impact on young people, both in the present and potentially long term (Espelage & Swearer, 2008; Russell et al., 2011; Toomey et al., 2010). These negative repercussions need to be addressed with staff. Other times, school personnel fail to intervene because they feel they do not know “how” to do this effectively. As a result, these policies must be accompanied by regular training for staff regardless of their position or role—for teachers, counselors, facilities workers, food services staff, and others.

The University of Delaware has an excellent set of recommendations for teachers and parents on how to address and intervene in cases of bullying (http://www.education.udel.edu/wp-content/uploads/2013/01/Bullying.pdf).

All school districts need to develop guidelines that promote not only safety, but also the positive development and education of gender-diverse youth. While the starting point is creating an inclusive educational environment, this must be followed by specific policies that address the unique needs of gender-diverse students. This section outlines specific policies that protect and affirm these young people.

Areas School Guidelines Should Address

Policies and forms that reflect gender-inclusive language

Use of affirmed name and pronouns

Names on official school records

Use of bathrooms

Use of locker rooms

Typically gender-segregated activities, such as sports teams, choirs, theater roles, etc.

Physical education classes

Dress codes

Confidentiality

Staff education

All school policies—not just those specific to gender-diverse students—need to reflect gender-inclusive language. Typically, students are referred to—verbally and in writing—as boys and girls or as young men and women. These categories must be broadened to include youth whose gender identity may not be reflected within the male/female binary construct. This can include eliminating the use of male/female language (“boys”/“girls”) where possible, or by adding language such as “transgender” or “gender-diverse.”

Shifting this language signals to staff, parents, and students that the school is aware that not all students fit within the binary gender construct. It communicates the school’s understanding that some students may identify as gender-diverse. This is essential for several reasons. First, simply acknowledging the existence of gender-diverse youth is a sign of respect, validation, and inclusion. Second, these changes facilitate increased awareness of the presence of gender-diverse youth among both staff and parents. Third, including gender-diverse youth within school policies affirms trans youth and signals that the administration views them as important members within the school community. The latter not only positively impacts gender-diverse youth but sends a clear message of inclusion and affirmation to the entire student body.

Most official forms, such as applications or intake forms, require that we “check” the male or female box to indicate our sex/gender. Schools need to review these documents and ensure that gender-diverse students are able to identify themselves in ways that are consistent with their gender identity rather than being forced to choose a box that does not describe them.

1.Sex assigned at birth ___________________________

2.Gender identity ___________________________

3.Male ___________________________

4.Female ___________________________

5.Transgender ___________________________

6.Other ___________________________

Schools must develop policies that support the use of affirmed names and pronouns for all gender-diverse students. As indicated before, using the young person’s affirmed name is a sign of basic respect. It also validates the student’s affirmed gender identity. When school personnel insist on using a student’s birth-assigned name despite requests for their affirmed name and pronouns, it sends the message that “we do not see you for who you are” and “we do not believe you are who you know yourself to be.” As discussed previously, microaggressions like these invalidate the experiential self-awareness and reality of gender-diverse youth, demeaning them and communicating that they are lesser human beings. The fact that these incidents are small interactions does not diminish their cumulative effect and demeaning impact and power.

Policies about the student’s affirmed name and pronouns must be addressed both in terms of how the youth is addressed informally by teachers, coaches, counselors, and peers and within official school records. While official school records may need to use a student’s birth-assigned name until it has been legally changed, it is essential to develop policies that also allow the inclusion of the student’s affirmed name. This policy becomes particularly relevant with substitute teachers, who rely on the “official” roster for students’ names.

Josie socially transitioned between eighth and ninth grade, beginning high school in her affirmed gender. Several middle schools funneled into her high school, meaning that most students met Josie as a young woman; they did not know her before she transitioned. The family filed the name change petition in July, but the approval process was delayed. As a result, the legal name on the school records remained her birth name.

When the parents met with the high school in August, the principal and guidance counselor were very supportive. Despite the official records, her teachers were informed about her transition, and they consistently used “Josie” and female pronouns. However, the first time one of the regular teachers called out sick, the substitute teacher read the name on the official roster—her legal birth name, thus outing Josie as a transgender student to her classmates.

This illustrates the importance of developing guidelines that allow the use of a student’s affirmed name, even when the legal name has not yet been changed. Without incorporating the youth’s affirmed name within the official records, the student’s trans identity may be inadvertently disclosed, potentially subjecting them to ridicule or harassment from peers as well as to experiencing the more internal negative consequences associated with microaggressions, such as fear, shame, and dysphoria.

Beyond developing gender-affirmative guidelines, schools must ensure that all staff receive adequate education and training. This should include information about gender development, gender identity, and gender expression; the particular needs of gender-diverse students; specific steps staff can take to be strong allies for trans youth; knowledge of local resources (such as trans or LGBTQ youth programs/groups); and information about signs that may indicate a student is at risk of drug and/or alcohol use, high-risk sexual behavior, self-harm, or suicide.

Providing education for parents also facilitates the development of safe, inclusive educational environments. The school’s gender policies need to be shared with parents along with other standard informative material, or these policies can be included in the school handbook sent home with each student. Some school districts organize educational presentations about gender diversity, gender identity, and gender expression for parents, which may include relevant videos, presentations by medical and mental health providers knowledgeable about gender development and gender identity in youth, a panel of community members, or table displays run by affirmative local youth programs or agencies. Schools can develop a resource guide for families that includes books, websites, and local support groups and organizations.

Given the centrality of peer relationships, developing a safe, inclusive educational environment necessitates student education about gender identity and expression. This material can be incorporated into larger conversations about gender diversity or discussions about current events as well as explored in more focused ways, such as classroom reading and assignments, school assemblies, and student fairs. Curriculum development needs to include positive material about transgender and nonbinary youth and adults.

In addition to “verbal” or written materials and activities, safety and support can also be communicated visually in the selection of images within classrooms and hallways. One middle school I visited had “Safe Space” signs at the entrance to every classroom. One place these stickers and posters are available is through GLSEN. Hard copy stickers and posters can be purchased for a nominal fee; digital downloads are free. http://shop.glsen.org/products/glsen-safe-space-kit?variant=11303798214

Work with students needs to challenge myths and stereotypes about transgender people and offer factual information that will facilitate understanding. Students need education about the various forms harassment and bullying may take (verbal, physical, online, etc.) as well as the harmful effects of these behaviors for both the recipient and the perpetrator. All students must know the process for reporting harassment, bullying, or abuse, including abuse centered around gender identity and expression. Students need to know safe places to go when experiencing harassment and safe school personnel to talk with if this happens to them or a peer. Concomitantly, the school needs to develop clear procedures to immediately address incidents of harassment or abuse that are reported by students or school personnel.

Supporting the development of Gay–Straight Alliances (GSAs) or pride clubs within middle and high schools is an important way schools can facilitate a safe, affirming environment for transgender and nonbinary youth. GSAs create opportunities for trans youth to meet each other, thus decreasing isolation and increasing their sense of support. The activities these student clubs plan facilitate a more positive sense of self, leading to pride in who they are. The teacher advisor can provide critical support for trans youth within the GSA. Given their visibility in this role, they may also become an identified resource for students who might not feel safe or ready to attend the club.

Given the name, Gay–Straight Alliances allow students who are questioning sexual orientation and/or gender identity and expression to attend without identifying as LGBTQ. They create safe spaces for LGBTQ students who are not ready to out themselves. The engagement of both LGBTQ and cisgender and straight peers facilitates the development of LGBTQ allies among the student body. It increases the number of non-LGBTQ youth willing and trained in how to stand up when they see another student being harassed or bullied. The participation of non-LGBTQ students increases the number of students who are knowledgeable and affirming of their LGBTQ classmates. It leads to non-LGBTQ students initiating classroom conversations, speaking up about issues of discrimination, and taking responsibility to create a safer, more welcoming climate at the school. Several studies indicate that the very presence of a GSA in a school increases the sense of safety for gender-diverse youth (Russell, Muraco, Subramaniam, & Laub, 2009; Toomey, Ryan, Diaz, Russell, 2011).

Students have the right to start a GSA in their school when none exists. The Equal Access Act, passed in 1984, requires all federally funded secondary schools to provide equal access to extracurricular clubs. All school-affiliated student organizations, including a Gay–Straight Alliance or pride alliance, must be treated equally in comparison to other student clubs. If a school permits student groups, it cannot ban certain types of groups or single them out for unequal treatment.

Many of the issues transgender and nonbinary youth encounter within their schools may also emerge within the context of other youth-serving programs and activities. Community programs and youth-serving agencies may resist using the young person’s affirmed name and pronouns. Programs like scouting, community sports teams, and day/overnight camps may be gender-segregated, and their policies about accepting transgender children/youth vary. For example, the Girl Scouts organization has publicly affirmed that transgender girls are welcome. Their position states, “If the child is recognized by the family and school/community as a girl and lives culturally as a girl, then Girl Scouts is an organization that can serve her in a setting that is both emotionally and physically safe” (Girl Scouts, 2016). While the Boy Scouts organization lifted its ban on gay members in 2013 and its ban on gay adult leaders in 2015, these shifts did not address inclusion of transgender members or leaders (ACLU, 2015).

Co-ed programs, whether day programs or overnight camps, may or may not allow transgender youth to use the restrooms that match their affirmed gender. Sleep-away camps may not allow transgender campers to bunk with peers of their affirmed gender. These are all challenges that parents and trans youth may encounter as the young person begins to move through the world in their affirmed gender.

Focused on creating safe and affirming schools for all students, regardless of sexual orientation, gender identity, or gender expression, GLSEN offers extensive resources for K-12 classroom discussions and activities, professional development materials for teachers and administrators, and programming support for GSA’s and other student clubs. http://www.glsen.org

Advocates for Youth has two excellent resources for developing safe programs for LGBTQ youth:

1.“Tips and Strategies for Assessing Youth Programs and Agencies.” http://www.advocatesforyouth.org/component/content/article/972-tips-and-strategies-for-assessing-youth-programs-and-agencies

2.“Creating Safe Space for GLBTQ Youth: A Toolkit.” This article includes lesson plans for building respect and tolerance among youth and strategies for creating safe space within an organization. http://www.advocatesforyouth.org/publications/608?task=view

Many mental health providers view their primary role as a clinical one. However, when working with transgender or gender-diverse children and adolescents, it is essential to be prepared to function as both an educator and advocate and not solely as a clinician. Many schools and other youth programs need accurate information about transgender youth. While many parents take on this challenge, some program directors may not view parents as objective or reliable sources of information. They may view the parents as focused on their child’s inclusion and not on what the director or board of directors may see as in the best interest of the program. Camp or program directors may feel they need to prioritize possible risks for the program over the needs or desires of an individual camper. Having a professional, who is often perceived as both an expert and more objective, speak to these concerns can play a significant role in shifting opinions about the full inclusion of gender-diverse children and teens, as illustrated in the following vignette.

Johnson (natal female) and his parents first came to see me in the spring of his sophomore year in high school. He had recently come out to his parents through an email as a transgender young man. Working together over the course of the summer, the family and I came to a consensus that he would begin 11th grade in his affirmed male gender. Johnson’s passion was theater, especially musical theater. He performed in every school production and had been involved with a local theater company for several years. There was some hesitation in both contexts about Johnson assuming male roles after he transitioned at school, but this was resolved fairly easily.

In the spring of that academic year, the community theater company began making plans for their summer theater day camp for elementary-age children. Johnson had served as a volunteer junior counselor in this program for the past two years and thoroughly enjoyed the work. In May, his parents received a call asking them to come in and meet with the director. They were informed that Johnson would not be able to return as a junior counselor because a parent of a camper had heard he was transgender and was adamant about not wanting her children around Johnson. She threatened to pull her children out of the program if Johnson was there and indicated that there were other parents who would do the same.

Both the parents and Johnson were understandably upset. This was the first significant negative response he had encountered about his gender transition. After processing their feelings about the director’s decision, the parents and Johnson asked if I would talk with the director. Over the next several weeks, the director and I spoke by phone on three occasions, each about 45 minutes long. At the onset, the director said there was no way he and the board of directors could risk having parents pull their children out of the program. The summer camp was the primary source of financial support for the fall and spring community productions. If too many families pulled out, the theater company could easily go under. They believed they could not take this risk for one adolescent when it might lead to the closing of the program for all young people. They wanted Johnson and his parents to understand that this was not about Johnson. The board and director wanted to support him in his transition. They did not want Johnson to feel upset about their decision but rather understand that it was solely financial and not about him.

I repeatedly acknowledged their fears about the possible financial loss if they allowed Johnson to return as a counselor and validated the difficulty of the board’s decision. I focused on listening to and even drawing out their concerns. I acknowledged their understanding that this was a financial decision that they believed was best for the well-being and longevity of the overall program and its work with all youth in the community—transgender and cisgender. I worked to ensure that the director felt heard by me. It was critical that he felt I understood and appreciated their concerns, as well as their support for Johnson.

In the midst of these conversations, there certainly was a part of me that found it challenging to be patient and understanding about the board’s refusal to accept Johnson back. There was a part of me that felt angry about their decision and the way it impacted my client. There was a part of me that identified with the rejection Johnson encountered in this situation. This part of me resisted—even resented—validating the board and director’s concerns.

These internal responses could have made it easy for me to align with Johnson and his parents in a way that could have interfered with my ability to engage the camp director. As a family therapist, I knew it was essential to build an alliance with everyone in this community system. Without this, I would not be able to help the director and board shift their position.

As a clinician, I also knew that when a client is upset about something, it is not possible to shift their beliefs or focus on taking actions before listening to and acknowledging the feelings they are experiencing. When a client is angry about being mandated to treatment, clinicians must begin by staying with that anger—drawing it out, encouraging the client to fully express it, validating the reality and even the legitimacy of the client’s anger. Even when the clinician believes the client is responsible for the actions that led to their being mandated, challenging the client’s right to feel angry or dismissing it as irrelevant only increases the client’s anger and resistance. When that occurs, the engagement process is sabotaged and the possibility of growth or progress is diminished or even eradicated.

These clinical tools—building an alliance with each member in a system and validating each member’s feelings in the moment—are also critical advocacy tools. As mental health professionals, our clinical skills of sitting with our own countertransferential responses, rather than acting them out with clients, are essential to effective advocacy for transgender youth and their families. I could not afford to act out on my anger about the board’s decision. There are some moments when I can channel or draw upon my anger about an unjust decision, but this must be a conscious and intentional therapeutic choice. I cannot be an effective clinician or advocate when I allow my emotions to determine my responses. Learning to transform clinical knowledge and skills into effective advocacy tools is invaluable in this work.

When I sensed that the director truly felt heard about the challenges of their decision, I was able to lean into our newly established alliance and also indicate that the decision would likely lead to Johnson feeling rejected. I gently but firmly suggested that being told he could not return to camp because of his gender transition would send a message that who he was as a transgender youth was not acceptable.

We went back and forth about these challenges several times. In the course of our initial phone call, I provided basic education about gender identity among adolescents and the needs of transgender youth. I addressed the importance of acceptance and support from the adults in their lives. As the call ended, I offered to forward fact sheets about gender identity and expression and transgender youth for him to share with the board of directors.

On our second call, the director reported back from his conversation with several board officers. He said they were still anxious about the potential financial risks if they allowed Johnson to return. I engaged him about the theater program they oversaw, asking him to tell me more about it. I asked him what was unique about their program, what its mission was, what they believed was the value of theater for children and teens. The director eagerly talked about the ways acting facilitates self-expression among youth. He expressed the board’s belief that acting can help young people explore who they are within a safe context, that being involved with the theater allowed the young to try on varying ways of being in the world without needing to commit to any single way if it did not fit them. In discussing the program’s mission, the director shared their commitment to creating an environment where young people could feel safe to express their thoughts and feelings and build self-confidence about their identity in the world.

Engaging the director about the program’s mission opened the door for an intervention that held the potential for change within this system. I leaned into their commitment to create a safe space for all youth and linked this to their decision about Johnson. Again, gently but firmly, I suggested if Johnson was not allowed to return to camp, it would send a message that contradicted their mission, not just to Johnson, but to all the campers. The current decision would communicate that youth were not, in fact, able to bring their whole selves to the theater program—that instead there were some aspects of identity not welcomed within the group. Reaching back and acknowledging the board’s concerns, I suggested that this message seemed to contradict their mission.

I could sense the director absorbing the impact of the board’s decision to ban Johnson’s participation that summer and how this negated the theater’s commitment to creating a safe space for self-exploration and expression among the children and teens who participated. He acknowledged the tensions within this dilemma, yet indicated he was not sure how to navigate this with his board.

I shared that there was a gender identity/expression nondiscrimination bill in that county. I stated that I hoped he and the board would allow Johnson to return to camp because it would be consistent with the message they wanted to convey to the young people. At the same time, it was also possible for the board to simply tell parents it was against the law to reject Johnson because he was transgender. He agreed to think about this and talk further with his board.

When we spoke the third time, the director told me our discussion about their mission had moved him. He and the board leaders had discussed this and decided that the right thing was to allow Johnson to return. I validated their courage in making this decision and said I believed it was the right thing to do and could even strengthen the values of their program.

We spent the remainder of that conversation strategizing about how to deal with parents who might oppose the decision to support Johnson’s return as a counselor. One option was to inform all the parents about Johnson’s transition and his return. Another option was to allow Johnson to return and respond to any parental objections individually as they arose. The director and board chose the latter approach. Camp staff, including Johnson, were told to direct questions or concerns from parents to the camp director or his assistant rather than responding to them on their own. This ensured consistent messaging about the board’s decision being reflective of the camp’s mission. In the end, the summer camp went smoothly with only one parent asking questions about Johnson’s transition.

This vignette highlights the critical role mental health practitioners can play in advocating for gender-diverse young people and their families. This was a situation where my outside knowledge could have a greater impact than parental advocacy alone. In addition to needing information, the director needed to be able to process his fears about potential financial losses, explore how to address the issue further with the board of directors, and then strategize how to respond to potential parental objections. These conversations would have been difficult to work through with the parents, and he and the board did not have enough knowledge about trans youth and gender identity to explore alternative decisions without outside consultation.

The vignette also illustrates the openness and patience often required in advocacy efforts. The same skills that enable us to sit with an individual client’s emotions and struggles without injecting our personal feelings or reactions can be called upon in building alliances with those who appear rejecting or unwilling to support transgender youth.

If I had reacted too strongly to the director’s initial statements that they could “not afford” to allow Johnson to return, this could have prematurely terminated our conversation. If I had pushed my own “agenda” about full inclusion of trans youth too soon or too forcefully, the director might have felt his concerns were not taken seriously. If I had dictated what he should do rather than inviting and validating the challenges he faced, our discussion would likely have had a less positive outcome.

In addition to advocating for an individual young person, it is critical for parents and providers to address larger local, state, and federal policies and laws that impact transgender youth. This could include your local school board; neighborhood and community groups, agencies, or organizations; your local municipal government; state policies and legislation; and national concerns affecting transgender and gender-diverse young people and their families.

Mental health providers cannot work with trans youth and their families in a way that provides clinical services in a vacuum. Counseling and other therapeutic services must always be grounded in the social and legal context in which these youth and their families live. If clinicians attempt to ignore or distance themselves from the larger issues of societal stigma and discrimination that trans youth encounter daily, their therapeutic efforts will become irrelevant.

•Create a visibly welcoming environment. Use “Safe Space” posters and stickers. Have trans-relevant and trans-affirming information available in your reception area or lounge— brochures, fliers, or magazines.

•Ensure that written policies about kindness and respect are communicated to everyone, including personnel, parents, and students/young people.

•Be clear that staff can hold any personal belief but must adhere to the organization’s policies about respect, kindness, and nondiscrimination in all interactions with young people.

•Provide staff training about gender development, gender identity, and gender expression. Educate staff about issues unique to trans youth, relevant and affirming community resources, and at-risk warning signs.

•Acknowledge, respect, and support a young person’s gender identity and expression.

•Ask what name and pronouns the young person would like you to use. Then refer to trans and gender-diverse youth by their preferred name and pronouns. If you don’t know what pronouns to use, ask politely and respectfully.

•Admit when you don’t know something or make a mistake. Don’t be afraid to apologize. Then move on. Don’t linger on your apology.

•Allow all youth to express their gender identity through their choice of clothing, hairstyle, and accessories.

•Do not attempt to change a youth’s gender identity or punish a youth for their gender expression. Do not label varying gender expression as “inappropriate sexual behavior.”

•Treat information about a youth’s gender identity as confidential to ensure their privacy.

•Don’t make assumptions about a transgender young person’s sexual orientation.

•Don’t assume what path a transgender youth is on regarding hormones or surgery.

•Listen to the voices of transgender youth. Treat them as the experts on their lives.

•Don’t expect one transgender youth to be the resident trans expert. As with any group, there is a lot of diversity within the trans community.

•Become comfortable with fluidity. Don’t insist on binary identifications. Don’t define someone else. Everyone has the right to choose the identities they feel best suit them.

•Trust that a young person’s decision to present themselves as gender-different from their birth-assigned gender is not made lightly or without due consideration.

•Do not sensationalize or sexualize trans bodies. It is generally inappropriate to ask a transgender person how they have sex or what their genitals look like. (This includes asking what surgeries a trans person has had or intends to have.)

•Ensure access to trans-knowledgeable and trans-affirming medical and mental health providers.

•Connect trans and gender-diverse youth to supportive community resources, programs, and services—or bring these resources to them.

•Educate young people about differences, including gender diversity and gender identity.

•Challenge put-downs and dispel myths and stereotypes. Stand up for gender diversity.

•Be an ally and advocate for trans and gender-diverse youth. Encourage ally building among youth.

•Confront harassment and bullying when they occur. This will make all youth feel safer.

•If appropriate in your setting, provide education for parents, including written communication about your organization’s gender policy.

•Provide educational presentations for parents and opportunities for discussion about gender diversity and transgender identity.

•Best practice generally houses transgender youth according to their affirmed gender identity, not their birth-assigned sex. Mixed-gender housing can be appropriate for trans youth.

•Transgender youth should rarely be placed with peers of their birth-assigned sex, and then only for safety concerns. If this is unavoidable, ensure that all staff respect and acknowledge the young person’s affirmed gender identity (e.g., by using the name and pronouns they request).

•Do not place transgender or gender-diverse youth in sex-offender programs or facilities; trans youth are not predators.

•Ensure that transgender youth have safe access to bathrooms—ideally a bathroom that matches their affirmed gender identity. If necessary, this can be a single-stall bathroom or a staff bathroom.

•Provide privacy and safety in shower facilities through a single-user facility, allowing showering at a different time from cisgender peers, or installing privacy barriers.

•Conduct necessary strip searches in a respectful and dignified manner. They should always be done in private and out of sight of peers or nonessential staff. Allow transgender youth to choose the gender of the staff person who conducts the search. Provide training in respectful and affirming treatment for trans and gender-diverse young people for all staff members.